Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review

Rita Jacobs; Robert D Wise; Ivan Myatchin; Domien Vanhonacker; Andrea Minini; Michael Mekeirele; Andrew W Kirkpatrick; Bruno M Pereira; Michael Sugrue; Bart De Keulenaer; Zsolt Bodnar; Stefan Acosta; Janeth Ejike; Salar Tayebi; Johan Stiens; Colin Cordemans; Niels Van Regenmortel; Paul W G Elbers; Xavier Monnet; Adrian Wong; Wojciech Dabrowski; Philippe G Jorens; Jan J De Waele; Derek J Roberts; Edward Kimball; Annika Reintam Blaser; Manu L N G Malbrain

doi:10.3390/life12091390

Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review

Life (Basel). 2022 Sep 6;12(9):1390. doi: 10.3390/life12091390.

Authors

Rita Jacobs¹, Robert D Wise^{2

3

4}, Ivan Myatchin^{5

6}, Domien Vanhonacker⁵, Andrea Minini^{5

7}, Michael Mekeirele⁵, Andrew W Kirkpatrick^{8

9}, Bruno M Pereira^{10

11}, Michael Sugrue¹², Bart De Keulenaer^{13

14}, Zsolt Bodnar¹⁵, Stefan Acosta¹⁶, Janeth Ejike¹⁷, Salar Tayebi¹⁸, Johan Stiens¹⁸, Colin Cordemans¹⁹, Niels Van Regenmortel^{1

20}, Paul W G Elbers²¹, Xavier Monnet²², Adrian Wong^{2

23}, Wojciech Dabrowski²⁴, Philippe G Jorens^{1

25}, Jan J De Waele²⁶, Derek J Roberts²⁷, Edward Kimball^{28

29}, Annika Reintam Blaser^{30

31}, Manu L N G Malbrain^{24

32

33}

Affiliations

¹ Intensive Care Department, Antwerp University Hospital, 2650 Edegem, Belgium.
² Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium.
³ Discipline of Anesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban 4001, South Africa.
⁴ Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK.
⁵ Intensive Care Department, University Hospital Brussels, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
⁶ Emergency Medicine Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
⁷ Department of Anesthesiology and Intensive Care, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy.
⁸ Departments of Critical Care Medicine and Surgery, The Trauma Program, University of Calgary, Victoria, BC V8W 2Y2, Canada.
⁹ The TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, AB T3H 3W8, Canada.
¹⁰ Department of Surgery, Health Applied Sciences, Vassouras University, Vassouras 27700, Brazil.
¹¹ Campinas Holy House Residency Program, Terzius Institute, Campinas 13010, Brazil.
¹² Donegal Clinical Research Academy and Emergency Surgery Outcome Advancement Project (eSOAP), F94 A0W2 Donegal, Ireland.
¹³ Department of Intensive Care, Fiona Stanley Hospital; Professor at the School of Surgery, The University of Western Australia, Perth, WA 6907, Australia.
¹⁴ Department of Intensive Care at SJOG Murdoch Hospital, Murdoch, WA 6150, Australia.
¹⁵ Consultant General Surgeon, Letterkenny University Hospital, F92 AE81 Letterkenny, Ireland.
¹⁶ Department of Clinical Sciences, Lund University, Box 117, SE-221 00 Lund, Sweden.
¹⁷ Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA 92354, USA.
¹⁸ Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), 1040 Etterbeek, Belgium.
¹⁹ Department of Intensive Care, AZ Sint-Maria Hospital, 1500 Halle, Belgium.
²⁰ Department of Intensive Care Medicine, Campus Stuivenberg, Ziekenhuis Netwerk Antwerpen, 2050 Antwerp, Belgium.
²¹ Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Vrije Universiteit, 1081 Amsterdam, The Netherlands.
²² Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, FHU SEPSIS, 94275 Le Kremlin-Bicêtre, France.
²³ Department of Critical Care, King's College Hospital NHS Foundation Trust London, London SE5 9RS, UK.
²⁴ First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland.
²⁵ University of Antwerp, Laboratory of Experimental Medicine and Pediatrics (LEMP), 2000 Antwerpen, Belgium.
²⁶ Intensive Care Unit, University Hospital Ghent, 9000 Ghent, Belgium.
²⁷ Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 1H3, Canada.
²⁸ Department of Surgery and Critical Care, U Health OND&T, Salt Lake City, UT 84105, USA.
²⁹ Department of Surgical Critical Care SLC VA Medical Center, Salt Lake City, UT 84148, USA.
³⁰ Department of Anesthesiology and Intensive Care, University of Tartu, 50090 Tartu, Estonia.
³¹ Department of Intensive Care Medicine, Lucerne Cantonal Hospital, 6110 Lucerne, Switzerland.
³² Medical Data Management, Medaman, 2440 Geel, Belgium.
³³ International Fluid Academy, 3360 Lovenjoel, Belgium.

Abstract

Background: General pathophysiological mechanisms regarding associations between fluid administration and intra-abdominal hypertension (IAH) are evident, but specific effects of type, amount, and timing of fluids are less clear.

Objectives: This review aims to summarize current knowledge on associations between fluid administration and intra-abdominal pressure (IAP) and fluid management in patients at risk of intra-abdominal hypertension and abdominal compartment syndrome (ACS).

Methods: We performed a structured literature search from 1950 until May 2021 to identify evidence of associations between fluid management and intra-abdominal pressure not limited to any specific study or patient population. Findings were summarized based on the following information: general concepts of fluid management, physiology of fluid movement in patients with intra-abdominal hypertension, and data on associations between fluid administration and IAH.

Results: We identified three randomized controlled trials (RCTs), 38 prospective observational studies, 29 retrospective studies, 18 case reports in adults, two observational studies and 10 case reports in children, and three animal studies that addressed associations between fluid administration and IAH. Associations between fluid resuscitation and IAH were confirmed in most studies. Fluid resuscitation contributes to the development of IAH. However, patients with IAH receive more fluids to manage the effect of IAH on other organ systems, thereby causing a vicious cycle. Timing and approach to de-resuscitation are of utmost importance, but clear indicators to guide this decision-making process are lacking. In selected cases, only surgical decompression of the abdomen can stop deterioration and prevent further morbidity and mortality.

Conclusions: Current evidence confirms an association between fluid resuscitation and secondary IAH, but optimal fluid management strategies for patients with IAH remain controversial.

Keywords: abdominal compartment syndrome; abdominal hypertension; colloids; crystalloids; fluid therapy; hypertonic; maintenance; open abdomen; resuscitation; sepsis.

Publication types

Review

Grants and funding

No funding was provided except for support by WSACS (www.wsacs.org (accessed on: 26 May 2022)) and University Hospital Antwerp to cover the Open Access fee.